Eye pathologies affect not only the structure of the eye itself, but also the adjacent tissues of the orbit, and since changes occur in the circulatory system, the pathological states invariably affect the metabolic processes and the quality of the visual perceptions. One such process is a specific autoimmune inflammation, the cause of which are endocrine disorders. As a result of inflammation develops exophthalmos (oedemas) and ophthalmoplegia (loss of functionality of the oculomotor muscles).
Content
1Definition of disease
2Types and Classifications
3Causes
4Symptoms
5Possible complications
6Diagnostics
7Treatment
7.1Medication Therapy
7.2Surgically
7.3Folk remedies
8Prevention
9Video
10conclusions
Definition of disease
The first information about the disease was recorded in 1835. Irish physician Graves.However, to bind endocrine pathologies and so-called. Bazedov's disease (exophthalmos) was only possible in the 40s of the 20th century. And for a long time exophthalmos was considered a symptom of thyroid diseases.
For many years there have been debates about the primary and secondary nature of tissue damage to the orbit, which gave rise to a number of names pathological conditions: thyrotropic exophthalmos, endocrine exophthalmos, thyrotoxic exophthalmos, exophthalmic ophthalmopathy, etc. TThe term endocrine ophthalmopathy is recognized as closest to the true concept, giving an idea of the etiology and pathogenesis of the disease.
As a result of endocrine disorders, retrobulbar tissues are affected, leading to infiltration and puffiness, and a few years later - to the growth of connective tissue. Increasing the volume of fiber and muscle leads to "pushing" the eye out of the orbit.
If untimely or inadequate treatment changes can become irreversible.
Types and Classifications
The development of endocrine ophthalmopathy is characterized by the passage through 4 phases:
Inflammatory exudation(the release of inflammatory fluid from the blood into tissues);
Infiltration(penetration of foreign particles into the tissues);
Proliferation(proliferation of tissues);
Fibrosis(formation of scar tissue).
When classifying the severity of endocrine ophthalmopathy, Russian ophthalmologists use the B system. G. Baranov, according to which the division provides for 3 degrees:
1st- unexplained exophthalmos (up to 1, mm), as well as moderate swelling of the eyelids. Violations of oculomotor muscles are not observed;
2nd- moderately pronounced exophthalmos (up to 1, mm), pronounced edema of the conjunctiva, considerable edema of the eyelids, periodic doubling;
3rd- pronounced exophthalmos (more than 2 mm), persistent diplopia, ulceration of the cornea, inability to close the eyelids, signs of optic nerve atrophy.
Causes
The main cause of endocrine ophthalmopathy is autoimmune processes affecting both the thyroid gland and eye orbit (in 90%).In 10% of the pathology of the thyroid gland is not observed. Symptoms of eye damage can occur simultaneously with endocrine changes, precede them or appear even after 3-8 years. Disturbances in the functioning of the eyes can be an accompaniment with the following endocrine pathologies:
Thyrotoxicosis- in 60-90% of cases;
Euthyroid status - in, -25%;
Hypothyroidism- in, -15%;
Autoimmune thyroiditis- at, %.
Lighter forms of the disease are typical for young people, the disease in severe form more often affects the elderly. The provoking factors are:
Respiratory infections;
Autoimmune diseases;
Small doses of radiation;
Salts of heavy metals;
Insolation(irradiation with solar radiation);
Smoking;
Stress.
One of the risk factors is sex - women are several times more sick than men. In this case, the symptomatology of male patients is heavier. The average age of patients is 30-50 years, but the severity of the manifestations increases with age.
Symptoms
Depending on the strength of the symptoms, there are 3 forms of the disease:
Thyrotoxic exophthalmos. It is characterized by protrusion of eyeballs, retraction (elevated state) of the upper eyelid, tremor (shaking) of closed eyelids, disorder of binocular vision;
Ophthalmic exophthalmos. For this form of the disease is characterized by the presence of exophthalmos up to 30 mm, swelling of periorbital tissues in both eyes, limitation of eye mobility, diplopia (double vision). With the progression of the disease there is a lack of eyelid, corneal ulcers, pain in the orbit, chemosis (swelling) of the conjunctiva, venous stasis (difficulty in outflow of blood);
Endocrine myopathy. Characteristic features of this form of the disease are the weakness of the straight eye muscles, resulting in diplopia, deviation of the eyes down, strabismus and other visual impairments.
Symptoms in the initial stages of the disease include pressure in the eyes and a feeling of "sand dry eyes or watery eyes, photophobia, swelling of periorbital tissues.
Possible complications
Endocrine ophthalmopathy is a difficult and difficult disease to treat.Even diagnosed in the early stages of the process requires a long and competent treatment, consideration of many factors and constant monitoring of the doctor.
Therefore, the development of complications is more likely even in the treatment of autoimmune disorders:
Decreased quality of visual perception;
Development of Diplomacy(double vision);
Violation of binocular vision;
Strabismus;
Ulcers on the cornea;
Reduction of protective functions with subsequent development of conjunctivitis and keratitis.
In addition to physiological abnormalities in the functionality of the eyes, as a result of the development of exophthalmos there appears a defect of a purely cosmetic plan - poplar eyes.
Diagnostics
Diagnostic measures include examination by an ophthalmologist and an endocrinologist using the following methods:
Visometry;
Perimetry;
Ophthalmoscopy;
Convergence study;Perimetry
Biomicroscopy;
Electrophysiological studies;
ExophthalmometryI (definition of deviation of eyeballs and height of distances);
Tonometry;
Methods of visualization (CT, MRI of orbits, ultrasound).Tonometry of the eye
To clarify the changes in the endocrine system, hormonal studies (free T3 and T4), At to thyroproxidase and thyroglobulin, ultrasound of the thyroid gland are carried out. If necessary (nodes in the thyroid gland more than 1 cm), a puncture biopsy is performed.
The mandatory sub-point of the examination is the detection of changes in humoral and cellular immunity.
Treatment
For the treatment of endocrine ophthalmopathy conservative, surgical, radial and combined methods are used.
Medication Therapy
Treatment with medicines can develop in two directions: symptomatic and pathogenetic.
For the prevention of keratitis in the subcompensation stage, the following are used:
Drugs such as artificial tear, various gels and drops that have protective effect;
Local glucocorticoids: Dexamethasone, Hydrocortisone.Used for minor manifestations of the disease: photophobia, lacrimation, sensation of a foreign body.Dexamethasone is used in the treatment of endocrine ophthalmopathy
Pathogenetic treatment of medicines is prescribed only in the active phase:patients complain of photophobia and lacrimation, a feeling of bursting and sand in the eyes, pain in the eyeballs, increased eyeballs, puffiness of the eyelids and headaches. In this case, a course of treatment with systemic glucocorticoids is prescribed (Prednisolone, Methylprednisolone), have a pronounced anti-inflammatory effect and have a wide range of action on the immune system.Treatment is carried out for a long time with a gradual decrease in dosage.
Prednisolone - used in the treatment of endocrine ophthalmopathy
In the case of ineffectiveness of the methods used, pulse therapy is carried out-the administration of drugs drip for 3 days, followed by a repeat treatment in a reduced dose.
If the disease is at the stage of pronounced symptoms, it is possible to combine medical treatment with radiotherapy for eyeballs. This gives a more pronounced therapeutic effect than the use of only glucocorticoids.
Indication for carrying out special immunosuppressive and anti-inflammatory therapy can serve as the following conditions:
Progressive exophthalmoswith severe inflammatory symptoms;
Pronounced periorbital edema, combined with exophthalmos, chemosis, retraction of the eyelids and vascular congestion;
Relapse of the disease;
Moderate neuropathy of the optic nerve in the stage of compression.
Surgically
With ineffectiveness of conservative treatment or rapid progression of symptoms, treatment with operative methods can be performed. Surgical intervention in endocrine ophthalmopathy involves the use of three main techniques:
Decompression of the orbit. It is shown in the neuropathy of the optic nerve in the progressing stage and is intended to increase the volume of the orbit. Other possible indications for the operation are: ulceration of the cornea, pronounced exophthalmos, subluxation of the eyeball. Orbitotomy (decompression of the orbit) is achieved by resection of its walls (one or several), removal of retrobulbar fiber;
Surgery on oculomotor muscles.This type of surgical intervention can be used in the development of paralytic strabismus (not amenable to correction) or the emergence of persistent painful diplopia;
Operations on the centuries.Represented by a large group of functional and plastic interventions caused by a developed violation: spastic turn, lagophthalmus, retraction, prolapse of the lacrimal gland, etc.
Surgical intervention is performed only at the stage of remission of the inflammatory process or cicatricial changes. According to statistics, about 5% of patients need operative treatment.
Folk remedies
Endocrine ophthalmopathy is so complex in diagnosis and treatment that at the moment there is not even a single effective medical concept about therapeutic tactics.Therefore, talking about treating the disease with folk methods does not make sense - they simply do not exist.
Elimination of certain symptoms of the disease can be achieved by using the following means:
Decongestants:broth of wild rose or cranberry mors. Possessing high acidity, drinks accelerate the excretion of fluid from tissues and cells, thus reducing swelling in the eye area;
Antimicrobial:infusions of chamomile or calendula. Use of infusions as washes or compresses will help to eliminate the action of pathogenic microorganisms and strengthen the functionality of the mucosa;
Adaptogenic plants:sea-buckthorn, lemongrass, ginger, astragalus. Regular intake of beverages from these plants will increase immune defenses and allow more active resistance to the disease.
The use of funds according to folk prescriptions should only take place after a doctor's consultation and be an exceptionally complementary to the basic treatment.
Prevention
The main measure to prevent the development of the disease is the timely detection and adequate treatment of endocrine disorders.Thus, you exclude the main cause of development of endocrine ophthalmopathy.
However, sometimes the disease occurs and with the normal functioning of the thyroid gland. In this case, the only preventive measure is timely diagnosis, i.e. regular examinations of the ophthalmologist.
Video
conclusions
Statistics show that improvement in the treatment of the disease occurs in 30% of cases, and deterioration - in 10%.The remaining patients stop the stage of progression. Therefore, early diagnosis is still one of the most effective measures to prevent the development of the disease.
